Application for Membership

 

 

1953 Fremont Hills Drive 

Nixa, MO 65714 

417.725.1506 

 

Application for Membership 

 

Full Name: _____________________________   SSN: ______________________  Date of Birth: _______________ 

 

Residence Address: ______________________________  City: ______________________  Zip: ________________ 

 

Phone No: _______________________________  Email Address: ________________________________________ 

 

Company Name: _________________________________  Address: _______________________________________ 

 

Position: _____________________________  Number of Years: _________  Phone No: _______________________ 

 

 

Previous Address: _______________________________________________________________________________ 

 

Previous Company: ______________________________________________________________________________ 

 

Previous Company Address: _______________________________________________________________________ 

 

 

Name of Spouse: ______________________  Birth Date: ________________  Employer: ______________________ 

 

Number of children living at home: ________________ 

 

Name: ______________  Sex: __  Birth Date: ___________   Name: ______________  Sex: __  Birth Date: _______ 

 

Name: ______________  Sex: __  Birth Date: ___________   Name: ______________  Sex: __  Birth Date: _______ 

 

 

References: 

Current Bank: _____________________________  Previous Bank: _____________________________ 

 

Creditor 1: ________________________________  Creditor 2: ________________________________ 

 

Regular Member: _______________________________________  Phone No: ____________________ 

 

Non-Member: __________________________________________  Phone No: ____________________ 

 

 

Type of Membership Desired: 

 

Regular _____     Business _____     Corporate_____      Associate ______      Social _____     Non________ 

 

 

Deposit Attached (See fee schedule):  Total $ ___________  Check No: ____________ 

 

 

 

 

I understand my application is subject to the approval of the Board of Directors of Fremont Hills Country Club.  I 

agree that this Membership and all persons using the Club under this Membership are bound by and shall comply 

with all of the By-Laws, rules and regulations of the Club as they are written or shall be amended in the future.  I 

agree to be responsible for, and to pay all charges incurred under this Membership including all Club dues, charges, 

annual fees, assessments and any cost of collection including attorney fees.  I understand that by signing this 

application, making appropriate deposit or payment and subsequent approval of the Board of Directors of Fremont 

Hills country Club, this application shall constitute a legally binding agreement between the applicant and the club 

which will run from March 1

st

 through the last day of February of each year.  Renewal or resignation of membership 

will, as per the By-Laws, occur at the end of annual membership year.  I understand that if I elect to pay dues on a 

monthly basis, I will be obliged to sign a promissory note for payment of all dues for the annual membership. 

 

 

 

_______________________________________________________________ Date__________________ 

(Signature of Applicant) 

 

_______________________________________________________________ Date__________________ 

(Signature of Applicant) 

 

 

 

I hereby recommend the above applicant for membership at Fremont Hills Country Club. 

 

 

 

____________________________________________________________       ___________________ 

(Signature of Regular Member & Member Number)                                             (Date) 

 

 

 

 

Board of Directors Approval:  _________________________________________         _________________ 

 

 

 

 

  (Signature of Board President or Officer)                          (Date)